Treatment of life-threatening digitalis intoxication with digoxin-specific Fab antibody fragments: experience in 26 cases.
Treatment of life-threatening digitalis intoxication with digoxin-specific Fab antibody fragments: experience in 26 cases.
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地高辛特异性Fab抗体片段治疗危及生命的洋地黄中毒：26例经验。
DOI：
10.1056/nejm198211253072201
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发表时间：
1982
期刊：
影响因子：
--
通讯作者：
Phillips,A
中科院分区：
文献类型：
--
作者：
Smith,TW;ButlerJr,VP;Haber,E;Fozzard,H;Marcus,FI;Bremner,WF;Schulman,IC;Phillips,A
从绵羊中获得的地高辛特异性抗体的纯化Fab片段用于治疗26例晚期危及生命的地高辛（23例）或洋地黄毒苷（3例）毒性患者。这些患者有严重的心律失常，在某些情况下，高钾血症，这是抵抗传统的治疗。所有的患者都有一个良好的初始反应的剂量计算的Fab片段（在大多数情况下）是相当的，在摩尔的基础上，在病人的身体的强心苷的量。在4名接受长期低血压和低心输出量治疗的患者中，因脑或心肌灌注不足而死亡。在一例病例中，可用的Fab片段供应不足以逆转大量自杀性摄入地高辛，患者在复发性室性心律失常后死亡。在其余21名患者中，心律紊乱和高钾血症迅速逆转，随后完全康复。我们的结论是，使用纯化的地高辛特异性Fab片段是一种安全有效的手段，以扭转先进的，危及生命的洋地黄中毒。（《新英格兰医学杂志》1982年; 307：1357 - 1362）
Purified Fab fragments of digoxin-specific antibodies obtained from sheep were used to treat 26 patients with advanced, life-threatening digoxin (23 cases) or digitoxin (3 cases) toxicity. These patients had advanced cardiac arrhythmias, and in some cases hyperkalemia, which were resistant to conventional treatment.All patients had an initial favorable response to doses of Fab fragments calculated (in most cases) to be equivalent, on a molar basis, to the amount of cardiac glycoside in the patient's body. In four patients treated after prolonged hypotension and low cardiac output, death ensued from cerebral or myocardial hypoperfusion. In one case the available Fab fragment supply was inadequate to reverse a massive suicidal ingestion of digoxin, and the patient died after recurrent ventricular arrhythmias. In the remaining 21 patients, cardiac rhythm disturbances and hyper-kalemia were rapidly reversed, and full recovery ensued. There were no adverse reactions to the treatment.We conclude that the use of purified digoxin-specific Fab fragments is a safe and effective means to reverse advanced, life-threatening digitalis intoxication. (N Engl J Med. 1982; 307:1357–62.)